| Melasma is also called "melasma hepaticum", which, in Chinese medicine, belongs to "blackish facial patch","dusty complexion" etal. It is a quite common Facial pigment metabolism disorder of skin, which is more often seen in young and middle-aged women. The clinical manifestations are light-brown to dark-brown stains with clear boundaries in the face. The shape is irregular, and they are unequal in size and distributed symmetrically. The small ones look like butterflies or coins, while the big ones are like maps overspread the face. The boundaries are clear, and there is no scale or inflammation. If you press the stain, it won’t fade. With the development of the society, the stress from daily life and society grows. Together with the influence of some environmental facts, the morbidity of melasma is growing from year to year. Although this disease doesn’t bring much sensory symptoms to patients, and only a few of them feel slightly uncomfortable, but many patients have endocrine and autonomic nervous system function disorder symptoms like restlessness of the mind and irascibility, menoxenia and so on. While at the same time many patients lose their confidence, or even have anxiety-depression because of the disease, which brings a lot of pain to patients’life and spirit, severely affect patients’physical and mental life.Modern medical science considers that the nosogenesis of this disease is very complex, probably has something to do with incretion, heredity, ultraviolet rays, local microenvironment, oxyradical, and the use of pills and maquillage. There is no specific treatment for melasma. The mainstream method is external treatment in use of destructive ways to abrase the stains (like freezing, laser, etc.), which is fastm but may have some bad effects potentially. If this method is over used, the risk rises, which will easily cause exogenous melasma, adermotrophia, stains of permanent decolorization, Pigment rebound, etc. furthermore, the long-term effect is not good enough.External treatment of traditional Chinese Medicine is used in all ages, and scrapping is one of them. Scrapping is effective, safe, in expensive and has no side-effect. And the recurrence rate is low. Whi le propolis has functions of whitening, Anti-aging-skin, Anti-free-r adical-oxidation and Inhibition of tyrosinase activity. It can also r educe the production of Skin melanin and absorb ultraviolet rays. Whe n we combine scrapping and propolis, the curative effects are outstan ding. Now there are many studies about using traditional Chinese Medi cine to treat melasma, but there are still some deficiencies in clini cal practice, which is underscored by no unified standard in evaluati ng the curative effect, or subjective standards. This will make it ha rd to compare the curative effects, and it is also not good for Exten sive exchanges and research.Objective:Through the study of ancient and modern literature and clinical research, summarize the pathogenesis and manifestation of melasma, investigate the clinical efficacy and safety of scrapping combined with propolis in treating melasma, and provide a new therapeutic approach for clinical treatment of melasma.Methods:We use the method of randomized controlled clinical study. We randomly divide60patients who are in accordance with the inclusion criteria, into a regular needling group (30cases) and a scrapping-propolis group(30cases), according to "Diagnosis and curative effect standard of melasma (2003Revision)"The patients in scrapping-propolis group first get a scrapping in the order of The forehead area, the eye area, cheeks, lips, nose area, mandibular area. The technique requires are scrapping slowly, each area scrap3-5times. The stress must be tolerable, and cause slight skin fever of flush. And the process will be practiced4times in all. And secondly, after cleaning the face, put stain-shaped masks with propolis on the stains, which can totally cover the stains. The propolis is thinly and evenly applied on the masks, and the thickness of propolis is0.5-1mm. 30minutes later, remove the masks, clean the face again with clear water.In the regular needling group, the main acupoints are Zusanli (ST36), Sanyinjiao(SP6), Quchi(LI11), Xuehai(SP10), and the stain area. The matching acupoints:with stagnation of liver-Qi, use Taichong(LR3) and Hegu(LI4); with spleen-Qi efficiency, use Piyu(BL20) and Qihai (RN6); with kidney efficiency, use Shenyu(BL23) and Guanyuan(RN4); with blood stagnation, use Geshu(BL17). Use30-32, Φ0.32X25mm-50mm Hua Tuo brand stainless steel disposable acupuncture needle, after routine disinfection by75%alcohol, insert the needle fast(in the stain area, use encircling needling). After inserting all the needles, connect them to Shanghai G6805type electric acupuncture therapeutic instrument, using continuous wave, frequency is80times/min, the amount of stimulation to patients must be tolerate. Withdraw the needles30minutes later.Both groups of patients were treated3times a week,12times for a course of treatment. We evaluate the curative effect after two courses."Diagnosis and curative effect standard of melasma (2003Revision)", area of skin lesion, color of skin lesion, TCM syndrome score,"WHO Determination of quality of life scale","Self-Rating Anxiety Scale"," Self-Rating Depression Scale"," Bech-Rafaelsen Mania Rating Scale" and "Adverse drug reaction scale" are all used in the evaluations both before and after the treatments.Results:1. Among patients with melasma, the majority are married female brainworker between30-50years old. And middle and high income earners who received lower than university education level are more likely to have this disease.2. most of the patients with melasma are liver-Qi stagnation type, followed by blood stagnation type, kidney efficiency type and spleen efficiency type. Most of them are Secondary patients, and more of which are upper face type.3. The curative effect of scrapping combined with external application of propolis is significant with a total effective rate of90%, remarkably higher than regular needling group (P<0.05).4. The total effective rate of scrapping combined with external application of propolis used in treating melasma of liver-Qi stagnation type and blood stagnation type is100%, significantly higher than kidney efficiency type and spleen efficiency type (P<0.05).5. scrapping combined with external application of propolis can not only remarkably improve the area and color of the skin lesion, but also improve the symptom of restlessness of the mind and irascibility and menoxenia, which is significantly better than acupuncture treatment (P<0.05).6. scrapping combined with external application of propolis is significantly better than needling group in improving patients’quality of life and the state of anxiety and depression (P<0.05).7. scrapping combined with external application of propolis is safe and has no side-effect in treating melasma.Conclusions:The occurrence of melasma is related with liver, spleen and kidney, especially liver. Scrapping combined with external application of propolis can significantly improve the symptoms and raise the curative effect. Furthermore, it is safe with no side-effect, which is more receptible for the patients. So it worth spreading clinically. Patients with melasma have depression and anxiety in different degrees, so we should pay enough attention to patients’mental problems, appropriate psychological counseling can promote the rehabilitation of the disease. |
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